Monika Koch’s Hip: A Case Study
Monika Koch is a 36-year-old female who presented to the clinic with a history of a fall in 2018 that resulted in a fracture of the neck of her femur. She was treated surgically with a dynamic hip screw (DHS) but has since experienced a number of complications, including shortening of her leg, inability to bear weight, gross instability, and bilateral foot drop.
Medical History
- 2015: Monika was diagnosed with spinal cysts in her dorsal spine.
- 2018: Monika sustained a fall that resulted in a fracture of the neck of her femur. She underwent surgery to repair the fracture with a DHS.
- Monika has a history of dribbling of urine for the past 10 years.
Examination
- Monika’s leg is shortened by 4 cm.
- There is a healthy scar over her thigh.
- There is no obvious swelling, local temperature changes, or skin changes.
- Monika has bilateral foot drop with altered sensation at the L4-L5-S1 level.
- Monika has a large vesico-vaginal fistula.
X-rays
- The x-rays show that the DHS is in place but there is evidence of implant failure.
- There is also evidence of osteomyelitis, which is an infection of the bone.
Blood Tests
- Monika’s blood tests show that she has anemia (low hemoglobin).
- Her white blood cell count is elevated, which is suggestive of infection.
- Her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are also elevated, which are further suggestive of infection.
Aspiration
- An aspiration of the hip joint was negative for infection.
Next Steps
The next step in Monika’s care is to determine the best course of treatment for her osteomyelitis. This may involve a combination of antibiotics and surgery.
Possible Treatment Options
- One-stage implant removal and total hip replacement (THR)
- Two-stage implant removal and THR
- Two-stage implant removal, followed by a spacer, and then THR
Culture Results
- The culture results, including delayed culture, were negative.
- CBNAAT (cartridge-based nucleic acid amplification test) was also negative.
Conclusion
Monika’s case is complex and highlights the challenges that can be associated with treating osteomyelitis. A multidisciplinary approach is essential for ensuring the best possible outcome for patients with this condition.